Observations in acute care: evidence-based approach to patient safety

Both the National Patient Safety Agency and National Institute for Clinical Excellence have recommended that nurses must competently carry out observations, accurately interpret the data and make appropriate decisions on that data if unnecessary deaths are to be avoided. This review explores patient safety through a review of nurses' knowledge, skills and practices of recording observations in acute clinical settings (TPR, BP, blood glucose levels, blood oxygen saturation levels and neurological function). Findings from different research studies indicate the respiratory rate in particular is a sensitive indicator of clinical deterioration, but is the one observation that is poorly performed in acute care. The review also highlights the advantages and disadvantages of using electronic recording devices and using early warning systems that have been designed to identify patients at risk of deterioration. In addition to this, the review explores what nurses need to know about physiological compensatory mechanisms in order to facilitate accurate detection and reporting of clinical deterioration in acute care. Some recommendations for improving nurses' competence in doing the observations are considered. These recommend nurses should attend the ALERT course (acute life threatening events recognition and treatment), within the first eighteen months post qualifying if working in acute care. It is also recommended that further development of simulation exercises in both pre and post registration courses may help to foster 'what is best practice' for doing the observations in acute care.